Many workers’ compensation callers express the same frustration — The treating doctor is only treating one of my injuries while ignoring the others. I hear some version of this frustration every week. It’s common. Today, we’ll discuss a couple reasons why it occurs.
Here’s an example of what often happens — You suffer a serious work-related accident. For one recent client, it was a fall from a ladder. You hurt several different body parts in the accident. However, one of those body parts may initially appear to be the most injured. In my ladder example, the worker fell. He injured both knees, his hips and his back. However, one knee was really swollen, badly swollen. He could not put any weight on it. So, that’s the injured body part work comp focused on treating to the exclusion of the others. It’s wrong. That worker is entitled to care for all his work-related injuries.
Often, the employer only lists the most pressing injury in its written report. If you work around Huntsville, the employer is likely to send you for medical care initially to Occupational Health Group (OHG). When you go to OHG, those doctors are only listing or looking at the one body part. When the OHG doctor finally refers you to an orthopedic, it’s just for the one body part. In my example involving the worker who fell from a ladder, the orthopedic only saw him for his swollen knee.
What about that worker’s other injuries? After all, he fell from a ladder and is hurting in his knees, hips and back. Many injured workers continue to tell their doctor about these other injuries. Yet, the doctor neglects to note them in the records. Guess what? If the other injured body parts are not noted in the reports or records, then the insurance company has a pretty good chance of disputing them later in court. Make sure they are documented!
Don’t let the insurance company neglect your other injured body parts. Don’t let the insurance company or its doctors ignore the complaints or suggest you wait. The longer you delay documenting the other injuries, the harder it is to prove them later. Don’t let these injuries go undocumented or untreated. You are entitled to medical care. Your health and your claim are both at issue.
The Insurance Company Is Trying To Avoid Paying Medical Bills
Medical costs are a huge issue in workers’ compensation cases. As an injured worker in Alabama, you are entitled to medical care for all the injuries suffered in a work-related accident.
The insurance company knows it cannot ignore an injured body part that is hugely swollen, bleeding, or incapable of movement. But, it’s easy for the insurance company to ignore that nagging back or hip pain. It’s easy for the insurance company or its doctor to suggest you wait and deal with one problem at a time. Don’t fall for delay tactics. The problem is — That nagging pain can worsen over time if untreated.
By ignoring some of your injuries, the insurance company is saving medical costs. It’s avoiding costly medical bills. The insurance company knows that every passing week without documentation or treatment decreases the likelihood you can prove that injury in your claim. The insurance company can avoid costly medical care.
The Insurance Company Is Trying To Avoid Paying Proper Disability Benefits
Medical cost savings may be obvious. But, insurance companies can also avoid paying proper disability benefits as well.
How can the insurance company avoid paying proper disability benefits? The work comp laws in Alabama provide compensation based on mathematical formulas. If you are reading this, you may be cringing over the talk of math. I get it.
If the insurance company ignores parts of your injuries, it can change the formula under which you are compensated for a permanent disability. Let’s go back to my ladder fall discussion from earlier where the worker hurt his knees, hips and back. In that case, the insurance company only treated the knee and ignored the other problems before the injured worker called me.
Alabama’s work comp laws have a listing of certain body parts. If you permanently injure one of those body parts, the listing describes available benefits for that part. The body parts listed are often called scheduled members. And, your leg is listed. Since my ladder worker permanently injured his knee, he would be entitled to benefits for one leg, a listed body part. But, injuries to your hips, back, neck, spine, shoulders, head, and some other areas, are not listed. Instead, these injuries are called whole body injuries. And, the formulas for whole body injuries almost always provide greater benefits than the formulas for listed injuries. Keep that in mind. In my ladder fall example, if the worker documents impairments to his hips and back, then he may be entitled to the better whole body formula instead of the lesser scheduled member formula.
I’ve tried to condense a discussion about compensation formulas into a simple paragraph. All you really need to remember is that you need to have every one of your injuries documented and treated. It makes a difference on your healing and return to work. If you have permanent problems, it usually makes a big difference in the compensation owed you.
If you are dealing with a work comp claim and the insurance company or its doctor are ignoring injuries, let me know. I’m happy to talk and provide some ideas for you. If you are dealing with a permanent injury and the formulas are an issue, I’ll walk through the calculations with you.
From our office in Huntsville, the lawyers at Blackwell Law Firm represent people statewide following a serious personal injury. We’ve tried personal injury cases, including both workers’ compensation and car accident claims, in courtrooms across Alabama.